Wunderlich Syndrome: Early misdiagnosis with acute renal colic during COVID-19 pandemic
نویسندگان
1 Urologist at Shiraz Central Hospital, Shiraz, Iran
2 Pathologist at Shiraz Central Hospital, Shiraz, Iran
3 Professor and head of hematopathology and molecular pathology, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
4 Iran Blood Transfusion Organization, Shiraz, Iran
5 Urologist at Shiraz Central Hospital and Shahryar Hospital, Shiraz, Iran
6 Associate professor of surgery and transplantation at Shiraz Central Hospital, Abu-Ali Sina Hospital and Shiraz University of Medical Sciences, Shiraz, Iran
7 Dr. Hashemi Imaging Clinic, Shiraz, Iran
doi
10.30476/beat.2023.97913.1415چکیده
Wunderlich syndrome, also known as the spontaneous non-traumatic retroperitoneal hemorrhage, is anuncommon condition characterized by acute, spontaneous, non-traumatic renal hemorrhage into the subcapsularor perirenal spaces. The majority of the cases are caused by renal cell carcinoma or renal angiomyolipoma.Other causes are arteriovenous malformation, cystic renal disease, and anticoagulation medications. Theclassic presentation is “Lenk’s triad” of acute flank pain, palpable flank mass, and hypovolemia. The diagnosisis based on clinical suspicion and confirmed by a CT scan, which is the preferred imaging modality. Due tothe rarity of these cases and the wide range of clinical manifestations, the treatment is divergent ranging fromconservative management to nephrectomy. Herein, we present a case of massive right renal hemorrhage causedby warfarin toxicity that was initially misdiagnosed as acute renal colic due to the patient’s refusal to refer tothe clinic during Corona Virus Disease- 19 era and was later managed with a right nephrectomy.
